Use of physical restraint among the issues at mental health facilities, report finds

Use of physical restraint among the issues at mental health facilities, report finds
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Dilapidated and unsuitable premises, the use of physical restraint and failure to give staff up-to-date training are just some of the issues identified in inspection reports of four mental health facilities.

The Mental Health Commission (MHC) has published inspection reports for four mental health facilities in Dublin, Donegal and Roscommon. While three out of the four centres showed areas of improvements, 34 areas of non-compliance were identified by inspectors - 19 of which had a high-risk rating.

The Department of Psychiatry (DOP) in Letterkenny is an acute in-patient service. While there was a significant improvement in compliance in 2018 (49% in 2017 to 63% in 2018), the centre was non-compliant in 12 areas - 10 of those which had a high-risk rating.

In relation to the use of physical restraint, inspectors found that the registered medical practitioner did not complete a physical examination of the resident within three hours after the start of an episode of physical restraint. One resident was not informed of the reasons for, duration of, and circumstances leading to discontinuation of physical restraint. The reasons for not informing them were not documented.

In one case, the resident’s next of kin was not informed about the physical restraint and the reasons for not informing them were not documented.

The condition of the premises was also severely criticised by inspectors.

The approved centre was not kept in a good state of repair externally. There was no programme of maintenance in relation to the outdoor areas, including the gardens and garden furniture. Staff brought in their own personal lawnmower to cut the grass.

"There was a programme for painting and cleaning, and a cleaning schedule was implemented. Not all damage to property had been reported to the maintenance department for repair," said the report.

Other areas of non-compliance noted were around individual care plans, the transfer of residents, the documenting of general health assessments, risk management procedures and the training of staff.

The suitability of the premises was also an issue raised in the inspection of O'Casey Rooms, Fairview Community Unit in Phibsborough in Dublin.

The inspectors found it "unsuitable premises for both rehabilitation and the care of elderly residents". One of the conditions of its registration is that it implements a plan to close the unit and the MHC has prohibited any direct admission or transfers of residents to the approved centre, with the exception of current residents that are transferred back to it following treatment elsewhere.

Concerns around risk management procedures, staffing and individual care plans were also raised by inspectors.

The 44-bed Ashlin Centre located in the grounds of Beaumont Hospital which provides inpatient services for the North Dublin Mental Health Service was non-compliant in six areas and three of those had a high-risk rating.

Inspectors found that the clinical files of two patients who were treated as being unable to consent to receive treatment. In both cases, there was no documented evidence that the responsible consultant psychiatrist had undertaken a capacity assessment or equivalent. This matter was resolved during the course of the inspection.

The Department of Psychiatry at Roscommon University Hospital was praised for showing "a very significant improvement" from its inspection in 2017 but had a high-risk rating in relation to the areas of premises and staffing.

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